Eu mudo, nós mudamos? Perspectivas sobre o trabalho dos Agentes Comunitários de Saúde / I change, do we change? Perspectives on the work of Community Health Agents

Este artigo visa analisar o processo de trabalho e as perspectivas de mudanças, a fim de proporcionar reflexões sobre a prática cotidiana de 62 Agentes Comunitários de Saúde da cidade de Campo Bom, no Rio Grande do Sul, Brasil. Os dados obtidos foram coletados através de entrevistas individuais e questionários autopreenchidos, e a análise dos conteúdos foi feita a partir da construção do Discurso do Sujeito Coletivo. A maioria dos trabalhadores relata que haveria algo a ser modificado no seu processo de trabalho. Dentre os aspectos a serem modificados e/ou melhorados estão: burocratização do trabalho, reorganização das marcações de consulta, respeito, união das equipes, maior participação dos profissionais de saúde (médicos e enfermeiros) nas visitas domiciliares, equipes incompletas, automatização do processo de trabalho, grande número de famílias cadastradas, reconhecimento, ausência e/ou sucateamento de materiais básicos de trabalho

Falem bem ou falem mal, mas falem de mim: relação entre trabalho e qualidade de vida do agente Comunitário de Saúde / Any publicity is good publicity: rlationship between work and quality of life of the Community Health Agent

Este estudo objetivou estabelecer a relação entre o processo de trabalho e a qualidade de vida do grupo de agentes comunitários de saúde do município de Campo Bom, no Vale dos Sinos na região metropolitana de Porto Alegre. Se configurou do tipo descritivo exploratório, transversal, de abordagem quantitativa. Participaram desta pesquisa 62 Agentes Comunitários de Saúde, com faixa etária entre 23 e 61 anos, sendo 58 (93,5%) mulheres e 4 (6,5%) de homens. Os participantes responderam um questionário sobre dados sociodemográficos, socioeconômicos e de trabalho, e ao questionário WHOQOL-BREF. A execução desta pesquisa pôde confirmar estatisticamente o impacto do processo de trabalho nos diferentes domínios da qualidade de vida.

Quem somos nós? A identidade não tão secreta dos agentes comunitários de saúde / Who are we? The not-so-secret identity of community health agents

Este artigo teve como objetivo analisar o entendimento de 62 Agentes Comunitários de Saúde da cidade de Campo Bom, no Rio Grande do Sul (Brasil), sobre as definições estabelecidas por eles acerca de sua identidade, proporcionando uma reflexão referente às práticas do cotidiano do trabalho. As entrevistas individuais e questionários auto preenchidos foram analisadas pelo seu conteúdo a partir da construção do Discurso do Sujeito Coletivo. As percepções apontam para a autodefinição do agente como um trabalhador que possui escuta qualificada; elo entre a equipe e a comunidade; múltiplas ações, que muitas vezes vão além do estabelecido legalmente; realizações pessoais condicionadas ao "sucesso" profissional; trabalho sob a lógica da educação em saúde. Esta pesquisa demonstrou que, por vezes, é o próprio trabalhador que se coloca na condição de "super-herói", o que nos faz pensar o quanto os processos de trabalho devem ser amplamente e continuamente discutidos.

Compulsión glucídica en mujeres adultas y su relación con el consumo de psicofármacos / Carbohydrate compulsion in adult women and its relationship with psychotropic drug

En la mujer adulta declina la función ovárica y la producción de estrógenos, con sintomatología física y psíquica, alteración en la regulación del apetito y tendencia a la ingesta de hidratos de carbono. Los psicofármacos empleados para el manejo del estado anímico podrían provocar efectos secundarios, como modificación de la ingesta y peso corporal y efectos neuroendocrinos como regulación de la serotonina, entre otros. Objetivos: Identificar la asociación entre el consumo de psicofármacos y la compulsión glucídica en mujeres adultas. Materiales y Método: Se realizó un estudio analítico de corte transversal sobre 114 mujeres mayores de 40 años que asistieron al consultorio de climaterio del Hospital General de Agudos “Bernandino Rivadavia”. Se analizaron variables biológicas, antropométricas, conducta alimentaria y consumo de psicofármacos, recabadas mediante encuestas estructuradas, voluntarias y anónimas, y mediciones antropométricas. Para el análisis estadístico se utilizó SPSS 15.0, calculando medidas de tendencia central,comparación de medias y Odds Ratio (OR) con intervalo de confianza (IC) del 95%, test chi cuadrado (x2) y correlación de Pearson con nivel de significación p< 0,05. Resultados: El 67,5% de la muestra presentó sobrepeso u obesidad y el 48,2% circunferencia de cintura (CC) aumentada. El 69,3% refirió compulsión glucídica, siendo los panificados y el chocolate los alimentos de mayor elección en estos episodios. No se observó significación estadística entre las mujeres que consumían psicofármacos para mejorar la calidad de vida, y la presencia de compulsión o estado nutricional alterado. Conclusión: Las mujeres que consumieron psicofármacos no presentaron diferencias en la prevalencia de compulsión glucídica o el estado nutricional alterado...

The influence of process parameters in production of lipopeptide iturin A using aerated packed bed bioreactors in solid-state fermentation.

The strain Bacillus iso 1 co-produces the lipopeptide iturin A and biopolymer poly-γ-glutamic acid (γ-PGA) in solid-state fermentation of substrate consisting of soybean meal, wheat bran with rice husks as an inert support. The effects of pressure drop, oxygen consumption, medium permeability and temperature profile were studied in an aerated packed bed bioreactor to produce iturin A, diameter of which was 50 mm and bed height 300 mm. The highest concentrations of iturin A and γ-PGA were 5.58 and 3.58 g/kg-dry substrate, respectively, at 0.4 L/min after 96 h of fermentation. The low oxygen uptake rates, being 23.34 and 22.56 mg O2/kg-dry solid substrate for each air flow rate tested generated 5.75 W/kg-dry substrate that increased the fermentation temperature at 3.7 °C. The highest pressure drop was 561 Pa/m at 0.8 L/min in 24 h. This is the highest concentration of iturin A produced to date in an aerated packed bed bioreactor in solid-state fermentation. The results can be useful to design strategies to scale-up process of iturin A in aerated packed bed bioreactors. Low concentration of γ-PGA affected seriously pressure drop, decreasing the viability of the process due to generation of huge pressure gradients with volumetric air flow rates. Also, the low oxygenation favored the iturin A production due to the reduction of free void by γ-PGA production, and finally, the low oxygen consumption generated low metabolic heat. The results show that it must control the pressure gradients to scale-up the process of iturin A production.

Rapid development of multiple nuclear loci for phylogenetic analysis using genomic resources: an example from squamate reptiles.

Recently, as genome-scale data have become available for more organisms, the development of phylogenetic markers from nuclear protein-coding loci (NPCL) has become more tractable. However, new methods are needed to efficiently sort the large number of genes from genomic databases into more limited sets appropriate for particular phylogenetic questions, while avoiding introns and paralogs. Here we describe a general methodology for identifying candidate single-copy NPCL from genomic databases. Our method uses information from reference genomes to identify genes with relatively large continuous protein-coding regions (i.e., 700bp). BLAST comparisons are used to help avoid genes with paralogous copies or close relatives (i.e., gene families) that might confound phylogenetic analyses. Exon boundary information is used to identify appropriately spaced potential priming sites. Using this method, we have developed over 25 novel NPCL, which span a variety of desirable evolutionary rates for phylogenetic analyses. Although targeted for higher-level phylogenetics of squamate reptiles, many of these loci appear to be useful across and within other vertebrate clades (e.g., amphibians), and some are relatively rapidly evolving and may be useful for closely-related species (e.g., within genera). This general method can be used whenever large-scale genomic data are available for an appropriate reference species (not necessarily within the focal clade). The method is also well suited for the development of intron regions for lower-level phylogenetic and phylogeographic studies. We provide an online database of alignments and suggested primers for approximately 85 NPCL that should be useful across vertebrates.

Isolation and selection of phenol-degrading microorganisms from industrial wastewaters and kinetics of the biodegradation.

Among 22 species of microorganisms isolated from phenol-containing wastewaters, Candida parapsilopsis was found to be capable of growth on a medium with 1 g/L phenol. Kinetic parameters of phenol biodegradation in a batch reactor were determined by measuring biomass growth rates and phenol concentration as a function of fermentation time. The Haldane equation described cell growth adequately, with kinetic constants mumax = 0.174/h, KS = 11.2 mg/L and Ki = 298 mg/L.

Nisin production from Lactococcus lactis A.T.C.C. 7962 using supplemented whey permeate.

The influence of pH control and aeration (20% dissolved oxygen) on nisin production in a supplemented cheese whey permeate was examined during batch fermentation with Lactococcus lactis subsp. lactis A.T.C.C. 7962. A maximum nisin activity of 5280 i.u./ml of medium was observed in the raw extract of nisin after 9 h of fermentation with a constant pH at 4.9. However, the fermentation was continued until 24 h, when a decrease in the nisin activity was observed. The pH control did not influence the nisin production and aeration of the culture medium increased cell growth (biomass) but not nisin activity. The yeast Kluyveromyces marxianus, used as an alternative method to control pH, has not been efficient.

Community environmental health assessment in Peru's desert hills and rainforest.

Peru's expanding population and rapid urbanization--a result of migration to its largest cities--have stressed the country's public services infrastructure and the provision of public health and environmental health services. In response, the Ministry of Health established the General Directorate of Environmental Health (DIGESA), the branch charged with assuring adequate environmental health services to populations in rural and urban areas. The magnitude of the environmental health problems in peri-urban settlements, however, has exceeded the capacity of DIGESA to respond. The Urban Environmental Health Project is an effort to develop the ability of local communities to address these problems

Familial microscopic hematuria caused by hypercalciuria and hyperuricosuria.

We report 12 patients belonging to five different families in whom persistent isolated microhematuria was associated with hypercalciuria and/or hyperuricosuria. Four patients had episodes of gross hematuria, three patients had passed renal stones, and a history of nephrolithiasis was obtained in four of the families (80%). Calcium oxalate and uric acid crystals were commonly observed in the urine sediments. Urinary erythrocytes had a normal appearance on phase-microscopic examination. Reduction of calciuria and uricosuria by thiazide diuretics, allopurinol, forced fluid intake, and dietetic measures led to a persistent normalization of urine sediment with complete disappearance of hematuria. Determination of calcium and uric acid urinary excretions should be included in the study of familial hematuria.

Evolutionary relationships between HLA-B alleles as indicated by an analysis of intron sequences.

The HLA-B locus is the most polymorphic of the class I genes encoded within the human major histocompatibility complex. This polymorphism is mainly located in exons 2 and 3, which code for the molecule's alpha1 and alpha2 domains and includes the antigenic peptide binding site. However, information about adjacent non-coding regions (introns 1 and 2) has not been extensively reported but could be very important in establishing an understanding of the evolutionary mechanisms involved in the polymorphism generation of HLA-B and the Mhc loci. In the present work, introns 1 and 2 of 14 HLA-B alleles are studied and their significance is discussed; 10 have been sequenced in our own laboratory and the other 4 have been previously reported by others. Different serological families share the complete intron 1 sequence; at this region, 12 out of 14 HLA-B alleles could be included in four groups with the same intron 1 sequence: a) B*0702, B*4201, B*4801; b) B*27052, B*4002, B*4011; c) B*40012, B*4101, including B*4501, B*5001 (these latter two alleles have specific characteristics in both introns 1 and 2, which may reflect a common evolutionary pathway); and d) B*44031, B*44032. The other alleles, B*1402, and B*1801, do not have identical intron 1 sequences compared to any of the described groups, but share many similarities with them. The B*1801 evolutionary pathway seems to be very specific since it branches separately from other alleles both in intron 1 and intron 2 dendrograms. On the other hand, HLA-B allelic group distribution and similarities according to intron 1 sequences were not confirmed when using intron 2, especially in the cases of B*4002, B*4101 and B*4801. This would suggest that both point mutations fixed by genetic drift and gene conversion events are involved in HLA-B diversification. The latter events could be supported by the strong homology between intron 1 and, to a lesser extent, intron 2, and also the CG content within them. Finally, the precise knowledge of these non-coding regions could be important for developing DNA base typing strategies for the HLA-B alleles.

Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration.

We observed that some patients do not develop hypoalbuminemia despite the presence of massive proteinuria. To investigate whether the absence or presence of hypoalbuminemia could be a marker in the distinction between idiopathic focal segmental glomerulosclerosis (FSG) and FSG secondary to hyperfiltration, we reviewed all our patients with biopsy-proven FSG and persistent nephrotic-range proteinuria (>3.5 g/24 h). Patients who met these conditions were then separated into those with hypoalbuminemia (serum albumin level <3 g/dL; group I; n = 19) and those with normoalbuminemia (>3.5 g/24 h; group II; n = 18). All group I patients had nephrotic edema in contrast with the absence of edema in all group II patients. Serum cholesterol and triglyceride levels were significantly greater in group I. All group I patients had been diagnosed with idiopathic FSG. The diagnoses of group II patients were FSG secondary to massive obesity in eight patients (44%), vesicoureteral reflux in five patients (27%), and renal mass reduction in three patients (16%); only two patients (11%) in this group had idiopathic FSG. The case histories of 19 other patients with nephrotic-range proteinuria associated with hyperfiltering disorders (reflux nephropathy, massive obesity, renal mass reduction), but without renal biopsy, were also reviewed; despite massive proteinuria (5.8 +/- 3.1 g/24 h), serum albumin and total protein levels were always within normal values. In conclusion, patients with FSG secondary to hyperfiltration do not develop hypoalbuminemia or the other characteristic complications of nephrotic syndrome, despite the presence of massive proteinuria values.

Complete cDNA sequence of the HLA-DRB1*09012 allele.

Sequencing studies of HLA class II molecules have focused almost exclusively on exon 2. In this study the complete cDNA sequence of the DRB1*09012 allele is reported for the first time. This sequence was previously only partially published. In the DR9 antigen, two synonymous allelic variants (DRB1*09011 and 09012) were officially recognized, though it was later found that the first one contained an error and both sequences were, thus, identical.

Association of thin basement membrane nephropathy with hypercalciuria, hyperuricosuria and nephrolithiasis.

BACKGROUND: Familial persistent microhematuria with normal renal function is the most common presentation of thin basement membrane nephropathy (TBMN). Gross hematuria episodes and loin pain attacks are other manifestations of the disease. On the other hand, it has been shown that hypercalciuria (HC) and hyperuricosuria (HU) can produce both gross or microscopic non-glomerular hematuria, in addition to their role in renal stone formation. METHODS: We studied the prevalence of HC, HU and nephrolithiasis in a group of 27 biopsy-proven TBMN as well as in 19 non-biopsied first-degree relatives with persistent microhematuria and 25 first-degree relatives without microhematuria. A group of 27 patients with IgA nephropathy (IgAN) and persistent microhematuria, and another group of 20 healthy subjects without known renal diseases were selected as control groups. RESULTS: Ten (37%) patients with TBMN and 8 (42%) relatives with microhematuria showed HC and/or HU at presentation; relatives without microhematuria, IgAN patients and normal controls showed a significantly lower prevalence of HC and HU. The prevalence of previous nephrolithiasis among TBMN patients (25%) was significantly higher than in IgAN patients (3%; P < 0.05). Family history of nephrolithiasis was recorded in 14 (51%) of the 27 TBMN families, in contrast with 2 of 27 (7%) with IgAN and 1 of 20 (5%) in normal controls (P < 0.05). The prevalence of nephrolithiasis, gross hematuria bouts and loin pain episodes among TBMN patients and microhematuric relatives showing HC and/or HU at presentation (44%, 44% and 27%, respectively) were significantly higher than those of TBMN patients and microhematuric relatives with normal calcium and uric acid urinary excretions (10%, 7% and 3%, respectively; P < 0.05). At the end of follow-up (8.8+/-4.1 years in TBMN patients and 9.1+/-4.2 years in relatives with microhematuria), all the cases maintained normal renal function. CONCLUSIONS: We found a high prevalence of HC, HU, and nephrolithiasis among TBMN patients and relatives with microhematuria. Our study also shows a significant relationship between the presence of HC and/or HU and the prevalence of nephrolithiasis, gross hematuria bouts and loin pain episodes.

Miastenia Gravis en el Hospital Santo Tomás 1990-1997 / Myasthenia gravis in Santo Tomás Hospital 1990-1997

Myasthenia Gravis is an infrequent disease. Diagnosis and treatment must be done early to avoid high morbidity that can compromise patients lives. Nine cases were identified during the eight year 1990-1997 at the Santo Tomas Hospital of Panama city but one had to be excluded because he refused treatment. Most of the patients (7/8) had symptoms for more than 3 months. The diagnosis of Myasthenia Gravis requires a high index of suspicion and the clinical impressión must be confirmed by various diagnostic studies that include the edrophonium test, the repetitive stimulation test, the therapeutic test with pyridostigmine, the determination of acetylcholine anti-receptor antibodies and a CT Scan of the thorax. Medical treatment consists mainly of anticholinesterase agents and surgical treatment consists of thymectomy by means of an extended transternal ablation. Operative results were excellent, seven out of eight improved

Allelic diversity at the primate MHC-DMB locus: presence of a conserved tyrosine inhibitory motif in the cytoplasmic tail.

Ten new primate Mhc-DMB complete cDNA sequences have been obtained in chimpanzee (n=four), gorilla (n=three) and orangutan (n=three); this gene has not been previously studied in these species. Exonic allelism has been recorded all along the molecule domains and also in the leader peptide, but not in the transmembrane segment. An analysis of the residues critical in the conformation of the Mhc-DR peptide-binding site was done in order to look for a Mhc-DR homologue site; synonymous substitutions are favoured in this homologous HLA-DM region. This is another finding that supports the possibility that DM could not be typically presenting molecules. The immunoreceptor inhibition motif Tyr 230-Thr/Ser 231-Pro 232-Leu 233 (ITIM) is invariantly present in apes for at least 15 million years, and may have a double function: 1) To direct DMB-DMA molecules from the endoplasmic reticulum or cell surface towards the endosomal/lysosomal class II compartment and 2) to send an inhibitory signal to the cell in order to stop synthesis of unnecessary HLA-DR molecules, once all available antigenic peptides are loaded. Other molecules, like NK-cell receptors and Fc receptors, bear this type of tyrosine-based inhibitory motifs in order to switch off specific cell functions. DMB molecules (as previously shown in C4d molecules) do not present species-specific motifs in common chimpanzee, suggesting that this species is very close to gorilla or man; also, DMB, like C4d molecules, do not show a trans-species evolution pattern, suggesting the existence of extensive homogenization of DMB genes within each species or a recent generation of alleles. Finally, a clade grouping human and gorilla DMB cDNA sequences is obtained using a dendrogram (as for C4d trees); this is in contrast to others' results that obtain a human/chimpanzee clade using different DNA sequences.